Purpose: The aim of this retrospective study was to evaluate the relationship between admission base excess and clinical outcomes in postoperative patients with aortic dissection. Methods: Clinical data were extracted from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database. The association between admission base excess and mortality in postoperative patients with aortic dissection was assessed using multivariate Cox regression and Kaplan-Meier survival analysis. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were employed to evaluate the predictive performance of base excess for in-hospital, 30-day, 90-day, and 1-year mortality. Results: A total of 196 patients were categorized into the normal base excess (–3 to +3 mmol/L) group and abnormal base excess (<–3 or >+3 mmol/L) group. Multivariate Cox regression analysis revealed that arterial base excess was a significant predictor of all-cause mortality across all periods. Subgroup analyses showed no significant interaction effects.The area under the ROC curve for base excess ranged from 0.640 to 0.745, indicating comparable predictive performance to existing scoring tools. Conclusion Arterial base excess measured at admission is an effective and accessible predictor of mortality in patients with aortic dissection following surgical treatment.

Purpose: The aim of this retrospective study was to evaluate the relationship between admission base excess and clinical outcomes in postoperative patients with aortic dissection. Methods: Clinical data were extracted from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database. The association between admission base excess and mortality in postoperative patients with aortic dissection was assessed using multivariate Cox regression and Kaplan-Meier survival analysis. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were employed to evaluate the predictive performance of base excess for in-hospital, 30-day, 90-day, and 1-year mortality. Results: A total of 196 patients were categorized into the normal base excess (–3 to +3 mmol/L) group and abnormal base excess (<–3 or >+3 mmol/L) group. Multivariate Cox regression analysis revealed that arterial base excess was a significant predictor of all-cause mortality across all periods. Subgroup analyses showed no significant interaction effects.The area under the ROC curve for base excess ranged from 0.640 to 0.745, indicating comparable predictive performance to existing scoring tools. Conclusion Arterial base excess measured at admission is an effective and accessible predictor of mortality in patients with aortic dissection following surgical treatment.

Purpose: The aim of this retrospective study was to evaluate the relationship between admission base excess and clinical outcomes in postoperative patients with aortic dissection. Methods: Clinical data were extracted from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database. The association between admission base excess and mortality in postoperative patients with aortic dissection was assessed using multivariate Cox regression and Kaplan-Meier survival analysis. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were employed to evaluate the predictive performance of base excess for in-hospital, 30-day, 90-day, and 1-year mortality. Results: A total of 196 patients were categorized into the normal base excess (–3 to +3 mmol/L) group and abnormal base excess (<–3 or >+3 mmol/L) group. Multivariate Cox regression analysis revealed that arterial base excess was a significant predictor of all-cause mortality across all periods. Subgroup analyses showed no significant interaction effects.The area under the ROC curve for base excess ranged from 0.640 to 0.745, indicating comparable predictive performance to existing scoring tools. Conclusion Arterial base excess measured at admission is an effective and accessible predictor of mortality in patients with aortic dissection following surgical treatment.

Objective:To evaluate the robustness of fully automated adaptive planning for Ethos online adaptive radiotherapy (ART) based on the intelligent optimization engine (IOE).Methods:Clinical data of 11 stage ⅠB cervical cancer patients admitted to Peking Union Medical College Hospital between June 2021 and June 2022 were retrospectively analyzed. Original planning images and iterative cone-beam computed tomography (iCBCT) images of each radiotherapy treatment were acquired, and all patient data were imported into the Ethos simulator. IOE-based 9-field automatic plan generation was performed for 11 patients using Ethos, and the generated plans were sent to online adaptive radiotherapy simulation to obtain each online adaptive radiotherapy plan (273 fractions in total) and complete the simulated treatment. For comparison, manual plan design was performed based on the images and contoured structures used for online adaptive radiotherapy planning, and the manually plans created with evenly divided 9 fields. Dosimetric parameters, plan complexity parameters, and Mobius quality assurance (QA) pass rates were collected to compare and evaluate the robustness of the online adaptive radiotherapy plan in terms of organs at risk (OAR), target volume dosimetric parameters, and plan complexity by using paired t-test or rank sum test. Results:The online adaptive plan of cervical cancer had comparable planning target volume (PTV) coverage compared to the manual plan. For the clinical target volume (CTV) D 99%, online adaptive plan was significantly higher than the manual plan [(45.93±0.36) vs. (45.32±0.31) Gy, P<0.001]. For hot dose area, the maximum point dose (PTV D max) of adaptive plan was significantly higher than the manual plan [(49.89±1.25) vs. (48.48±0.77) Gy, P<0.001], but the PTV D 1% of adaptive plan was significantly lower than the manual plan [(47.22±0.29) vs. (47.59±0.48) Gy, P<0.001]. There was no statistical difference in the conformal index ( P=0.967). And there was significant difference in the homogeneity index, with same medians and less dispersion in adaptive plan ( P<0.001). For OAR dose, bladder D mean, rectal V 40 Gy, small intestine D mean of adaptive plan was slightly higher than that of the manual plan; the rectal D mean, small intestine D 2 cm3 of the adaptive plan was slightly lower than that of manual plan; dosimetric parameters of right and left femoral heads, spinal cord and bone marrow of the adaptive plan were better than those of manual plan. The adaptive plan had more monitor units (MU) than the manual plan, but the complexity of the adaptive plan was significantly lower than that of the manual plan (0.135±0.012 vs. 0.151±0.015, P<0.001). For Mobius γ pass rate (5%/3 mm), both adaptive and manual plans met clinical requirements. Conclusion:Ethos cervical cancer online adaptive plan, which is based on the IOE engine, demonstrates good robustness and ensures the quality of online adaptive plans generated for each treatment fraction.

Objective:To evaluate the automatic optimization performance and clinical feasibility of the intelligent optimization engine (IOE) in the Ethos online adaptive radiotherapy platform.Methods:Clinical data of 11 patients with postoperative cervical cancer treated with Halcyon accelerator were retrospectively analyzed. Manual planning was performed for all patients using the 4 full arc volumetric modulated arc therapy (VMAT) (Manual-4Arc) in Eclipse, with a prescription dose of 45 Gy/25F. Patient images and structures were imported into the Ethos simulator, and appropriate clinical goals were added based on clinical requirements. The target coverage was normalized to 95%. Automatic plan generation was conducted using IOE, resulting in 7, 9, and 12 field intensity modulated radiotherapy (IMRT) plans (IMRT-7F、IMRT-9F、IMRT-12F), as well as 2 and 3 arc VMAT plans (VMAT-2Arc、VMAT-3Arc). Dosimetric index comparisons were made between the Manual-4Arc plans and the 5 groups of IOE-generated plans through one-way analysis of variance. Based on the analysis results, Turky post hoc multiple comparisons were performed to evaluate the automatic optimization performance of IOE.Results:In terms of the high dose area, the IMRT-12F plans showed the lowest D 1% for the planning target volume (PTV), and there were significant differences compared to the Manual-4Arc plans ( P=0.004). Regarding target coverage, all groups produced clinical target volume (CTV) plans that met the clinical requirements. Although the Ethos online adaptive plans were normalized during planning, the PTV coverage was slightly insufficient. For organs at risk (OAR) close to the target, such as the bladder, there were significant differences in V 30 Gy, V 40 Gy, and D mean among the 6 groups of plans. The dose ranking for the bladder was generally as follows: IMRT-12F

Hearing loss is one of the common radiotherapy-induced complications of head and neck tumors, including nasopharyngeal carcinoma. These side reactions can be classified into acute or delayed types, which affect all structures of the auditory organs, resulting in conductive, sensorineural or mixed hearing loss. Up to 40% of patients develop acute middle ear side effects during radical radiotherapy, while approximately 1/3 develop late sensorineural hearing loss. The total radiation dose and tumor site appear to be the most important factors associated with the risk of hearing loss. The mechanisms of conductive and sensorineural hearing impairment are different. New radiotherapy techniques (three-dimensional conformal radiotherapy, intensity modulated radiotherapy, proton therapy) enable better dose distribution, lower dose to non-target organs, and gradually increase the feasibility of protecting normal tissues. The present article illustrates recent progress in radiotherapy-induced hearing loss, specially focusing on the occurrence, the mechanisms and related factors of ear toxicity, detection and diagnosis, and treatment.

Objective:To compare the dosimetric parameters and plan complexity between newly-delicated HyperArc (HA) and conventional volumetric-modulated arc therapy (VMAT) in the treatment of brain metastases.Methods:For 26 patients with brain metastases, HA, conventional coplanar (Cop) and non-coplanar (Non-cop) VMAT plans with a prescription dose of 9 Gy 3fx or 6 Gy 5fx were generated. The dosimetric parameters for planning target volume (PTV), RTOG conformity index (RTOG CI), Paddick CI, homogeneity index (HI), gradient index (GI), maximum dose (D max) of brainstem and dose-volume parameters of brain-PTV(V 2Gy-V 26Gy) were statisticaly compared among these three approaches. In addition, the monitor unit (MU) and the plan complexity parameters (including MCSv and AlPO) were statistically compared. Results:To prevent missed targets during treatment, all plans were established with RTOG CI of greater than 1.1. For Paddick CI, HA provided significantly higher conformity (0.89±0.019) than Non-cop (0.87±0.036, P=0.001) and Cop (0.88±0.017, P=0.003) VMAT. For GI, the fastest dose fall-off was noted in HA (3.35±0.64), followed by conventional Non-cop VMAT of (3.70±0.80), and conventional Cop VMAT of (4.90±1.85)(all P<0.05). For the brainstem sparing, HA plan performed better than Non-cop plan[(604.14±531.61) cGy vs.(682.75±558.22) cGy, P<0.05)]. For normal brain tissue sparing, HA approach showed significant reduction than conventional Cop and Non-cop VMAT (both P<0.05). For MU, HA approach (2 872.60 ± 566.93) was significantly lower than those of Non-cop VMAT (3 771.28 ± 1 022.38, P<0.05) and Cop VMAT (4 494.08 ± 1 323.09, P<0.05). In terms of plan complexity, the MCSv of Cop plan was the lowest, indicating that the complexity was the highest ( P<0.05). The AlPO of HA was significantly higher than that of Non-cop VMAT ( P<0.05), suggesting that the complexity of HA plan was lower ( P<0.05). Conclusion:For the treatment of brain metastases, HA provides better conformity, more rapid dose fall-off, better sparing of brainstem and normal brain tissues and less plan complexity compared with conventional VMAT.

Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.

OBJECTIVE: To investigate the role of pharmacist-led anticoagulation monitoring service for warfarin anticoagulation therapy in patients during hospitalization. METHODS: We retrospectively analyzed the data of 421 patients receiving warfarin anticoagulation therapy during hospitalization between April, 2016 and December, 2017. Of these patients, 316 received daily pharmacist-led anticoagulation monitoring service including checking the patients' International Normalized Ratio (INR) and other pertinent laboratory test results and reviewing medication changes and the patients' clinical status (monitoring group); the other 105 patients receiving warfarin anticoagulation therapy without pharmaceutical care served as the control group. The data including compliance rate of anticoagulant indicators, incidence and rate of prompt management of INR alert, thrombosis and bleeding events during hospitalization were analyzed among these patients. RESULTS: Compared with the control patients, the patients in the monitoring group showed a significantly higher percentage time within target INR range [(73.20±9.46)% (46.32±17.11)%, < 0.001] and a higher qualified rate of INR before discharge (98.42% 60.95%, < 0.001) as well as a higher proper INR-monitoring frequency (97.15% 66.67%, < 0.001). The patients in the monitoring group showed a significantly lower incidence of INR alert than the control patients (8.23% 20.00%, < 0.001) with also a much higher rate of prompt management (96.15% 33.33%). The two groups had similar incidences of clinical events except that the control group reported a higher incidence of minor bleeding episodes (9.52% 2.53%, =0.005). CONCLUSIONS Pharmacist-led anticoagulation monitoring service can significantly improve the effectiveness and safety of warfarin anticoagulation therapy for patients during hospitalization.
Anticoagulants ; Drug Monitoring ; Hospitalization ; Humans ; Pharmacists ; Retrospective Studies ; Warfarin

Objective:To explore the action path and the potential mediating effects of depression and physical diseases on the influencing factors of mild cognitive impairment(MCI) in community, and provide the theoretical basis for the construction of the strategy of cognitive regulation.Methods:A convenient sample survey was conducted on 252 mild cognitive impairment patients in the community undergoing screening using the general information questionnaire, Montreal cognitive assessment scale(MoCA) and geriatric depression scale(GDS-15)from January 2018 to June 2019. SPSS 22.0 and AMOS 22.0 softwares were used to conduct descriptive analysis, correlation analysis, structural equation model and confirmatory factor analysis.Results:The score of MoCA was 19.66±3.90 for all MCI patients. There were significant correlations among age, education, social frequency, physical exercise frequency and depression degree, the number of physical disease and MoCA( r=-0.440-0.487, P<0.01). The structural equation model fits well(χ 2/ df=2.476, TLI=0.885, CFI=0.916, GFI=0.919, AGFI=0.871, RMSEA=0.077). Mediation modeling analysis showed that age, education, social frequency physical exereise frequency had a direct effect on cognitive function(effect value was -0.183, 0.458, 0.237, 0.174, P<0.01). There were partly mediating effect of the number of physical disease between age, education, physical exercise frequency and cognitive function(effect value was -0.106, 0.078, 0.075, P<0.01), and there were partly mediating effect of depression degree between age, social frequency, physical exercise frequency and cognitive function(effect value was -0.075, 0.080, 0.050, P<0.01), and there were chain mediating effect of the number of physical disease-depression degree between age, education, physical exercise(effect value was -0.028, 0.031, 0.019, P<0.01). Conclusion:The cognitive management of MCI among community should focus on the elderly, low education level groups.In the implementation of exercise intervention to improve cognitive function of health management strategy, while to strengthen the effective management of physical diseases and negative emotion evaluation and dredging, to increase the effect of exercise intervention on cognitive function improvement.